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Updated: May 19, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Risk factors and the impact of comorbidities in patients developing urethral stricture after transurethral resection
Mahmut Uğurlu1, Ali Atan2, Cihat Aytekin3
1Department of Urology, Mardin Training and Research Hospital, Mardin, Turkey. dr.mahmutugurlu@gmail.com.
Insights
Coronary artery disease (CAD) independently increases the risk of urethral stricture after prostate surgery. Managing systemic conditions is crucial for reducing postoperative complications like strictures.
Area of Science:
- Urology
- Cardiovascular Medicine
- Metabolic Health
Background:
- Urethral stricture is a significant complication following transurethral resection of the prostate (TURP).
- The role of systemic comorbidities in stricture development post-TURP requires further investigation.
Purpose of the Study:
- To assess the association between cardiovascular and metabolic comorbidities and urethral stricture formation after TURP.
- To identify specific comorbidities that increase the risk of urethral stricture post-TURP.
Main Methods:
- Retrospective analysis of 713 patients undergoing bipolar TURP for benign prostatic hyperplasia.
- Propensity score matching created a cohort of 235 patients to control for confounding factors.
- Cox proportional hazards regression analyzed the association between comorbidities (smoking, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease) and urethral stricture development.
Main Results:
- Coronary artery disease (CAD), smoking, hypertension, and dyslipidemia were more prevalent in patients who developed urethral stricture.
- Multivariable analysis revealed CAD as the only independent predictor of urethral stricture (HR 2.06, p=0.04).
- The bulbar urethra was the most frequent site of stricture formation.
Conclusions:
- Coronary artery disease is independently associated with an increased risk of urethral stricture after TURP.
- Systemic disease burden, particularly cardiovascular health, is important for assessing and managing postoperative stricture risk.
- Further research into overlapping vascular and metabolic pathways may elucidate other contributing factors.
Purpose:
Urethral stricture remains a clinically relevant complication after transurethral resection of the prostate (TURP). While procedural factors have been extensively studied, the contribution of systemic comorbidities to stricture development is less well defined. This study aimed to evaluate the association between common cardiovascular and metabolic comorbidities and urethral stricture formation following TURP.
Methods:
A retrospective cohort of 713 patients who underwent bipolar TURP for benign prostatic hyperplasia between January 2021 and January 2024 was analyzed. Urethral stricture was identified in 47 patients (6.6%). Propensity score matching (1:4) was performed based on age, prostate volume, operative time, and PSA levels, yielding a matched cohort of 235 patients. Comorbidities including smoking, hypertension, diabetes mellitus, dyslipidemia, and coronary artery disease (CAD) were assessed using clinical records and prescription data. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify factors associated with time to urethral stricture development.
Results:
In the matched cohort, smoking, hypertension, CAD, and dyslipidemia were significantly more prevalent in patients who developed urethral stricture (all p < 0.05), whereas diabetes mellitus was not. In univariable Cox analysis, smoking (HR 2.13), hypertension (HR 2.76), CAD (HR 3.15), and dyslipidemia (HR 2.46) were significantly associated with an increased hazard of urethral stricture development. In multivariable Cox analysis, only CAD remained independently associated with the outcome (HR 2.06, 95% CI 1.02-4.16, p = 0.04). The most common stricture location was the bulbar urethra.
Conclusion:
Coronary artery disease was independently associated with urethral stricture development following TURP. Other comorbidities may contribute through overlapping vascular and metabolic pathways. These findings highlight the importance of systemic disease burden when assessing postoperative stricture risk and planning perioperative management.
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